Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
difficulty in
breathing
Convulsions
Persistent
vomiting
Abdominal
distension
Severe
umbilical
infection
flaring of the nostrils, groaning or
grunting, severe sub-costal
retraction.
Features of convulsions are often
atypical in the newborn, such as a
“staring” look, blinking of eyelids,
“chapping” movements of the lips,
clonic/tonic movements of the limbs.
Occasional vomiting is common but
persistent vomiting is abnormal, as
is green-colored vomitus.
Distension or fullness of the
abdomen.
Spreading redness or swelling
around the umbilicus and/or foul
smell, with or without pus discharge.
Do not attempt to feed a baby
that cannot swallow fluids.
o Check the baby frequently to
ensure that there is no additional
problem.
o If possible, contact the referral
center to inform them.
• Send a referral note with the mother
indicating:
o name and address of the mother
o date and time of birth
o problems if any at birth
o reasons for referral
o treatment given
o advice given
The first five danger signs are the most important. Although these are standard danger
signs, it is essential that health workers should look at babies carefully at least once a day in
adequate light while they remain in the facility. Even if they do not detect a specific danger
sign, health workers should take care if they feel the baby is “not looking or doing well”. In this
way, sick newborns can be identified and treated early which is particularly important in the
newborn period when the condition can deteriorate rapidly. Mothers should also be counseled
on these points to promote early careseeking.
Referral and Transport of Sick Newborns
The condition of the sick newborn with sepsis may deteriorate rapidly. It is important to stabilize
the baby prior to transfer. Some of the key tasks are noted below:
• Provide information and counseling to the mother and family.
• Explain to the mother and family members the problem and reason for the transfer.
• Answer their questions.
• Explain that even if the transport has its own risk, the required treatment cannot be
provided at the peripheral health center or at home.
• Describe what to expect at the referral center.
• Explain care of the newborn during transport:
o Keep the baby warm during the transport by placing him/her in skin-to-skin with the
mother, covered with a cloth, with or without blanket, depending on the weather. This
will also protect the baby from drafts and insects.
o To prevent hypoglycemia, offer breastfeeds. If the suck is weak or absent, try to feed
the baby expressed breast milk with a clean cup. Do not feed an infant who cannot
swallow.
o Check the baby’s condition frequently to detect other complications.
• Prepare the baby for transport:
o Arrange for the fastest means of transportation.
Integrated maternal and newborn care
Basic skills course
153